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Volume 3, Number 1—March 1997
Synopsis

Cryptosporidiosis: An Emerging, Highly Infectious Threat

Richard L. Guerrant
Author affiliation: University of Virginia School of Medicine, Charlottesville, Virginia, USA

Main Article

Table 1

Rates of Cryptosporidium infection among immunocompetent and HIV-positive persons in industrialized and developing areasabc

Patients with diarrhea Controls without diarrhea
Immunocompetent
Industr. 2.2%(0.26%-22%) 0.2%(0%-2.4%)
areas [n=2232/107,329] [n=3/1941]
Developing 6.1%(1.4%-40.9%) 1.5% (0%-7.5%)
areas [n=1486/24,269] [n=61/4146]
HIV-positive
Industr. 14%(6%-70%) 0%(0%-0%)
areas [n=148/1074] [n=0/35]
Developing 24%(8.7%-48%) 5%(4.9%-5.3%)
areas [n=120/503] [n=5/101]

aFrom 100 reports of 133,175 patients with diarrhea and 6,223 controls. bRanges given in parentheses. cData from reference (7).

Main Article

References
  1. Tyzzer  EE. A sporozoan found in the peptic glands of the common mouse. Proc Soc Exp Biol Med. 1907;5:123.
  2. Nime  FA, Burek  JD, Page  DL, Holscher  MA, Yardley  JH. Acute enterocolitis in a human being infected with the protozoan Cryptosporidium. Gastroenterology. 1976;70:5928.PubMedGoogle Scholar
  3. Current  WL. Human cryptosporidiosis. N Engl J Med. 1983;309:13257.PubMedGoogle Scholar
  4. Navin  TR, Juranek  DD. Cryptosporidiosis: clinical, epidemiologic, and parasitologic review. Rev Infect Dis. 1984;6:31327.PubMedGoogle Scholar
  5. Goldstein  ST, Juranek  DD, Ravenholt  O, Hightower  AW, Martin  DG, Mesnik  JL, Cryptosporidiosis: An outbreak associated with drinking water despite state-of-the-art water treatment. Ann Intern Med. 1996;124:459.PubMedGoogle Scholar
  6. Vakil  NB, Schwartz  SM, Buggy  BP, Brummitt  CF, Kherellah  M, Letzer  DM, Biliary cryptosporidiosis in HIV-infected people after the waterborne outbreak of cryptosporidiosis in Milwaukee. N Engl J Med. 1996;334:1923. DOIPubMedGoogle Scholar
  7. Adal  KA, Sterling  CR, Guerrant  RL. Cryptosporidium and related species. In: Blaser MJ, Smith PD, Ravdin JI, Greenberg HB, Guerrant RL, editors. Infections of the gastrointestinal tract. New York: Raven Press; 1995;72:1107-28.
  8. Zu  S-X, Li  J-F, Barrett  LJ, Fayer  R, Zhu  S-Y, McAuliffe  JF, Seroepidemiologic study of Cryptosporidium infection in children from rural communities of Anhui, China. Am J Trop Med Hyg. 1994;51:110.PubMedGoogle Scholar
  9. Ungar  BLP, Soave  R, Fayer  R, Nash  TE. Enzyme immunoassay detection of immunoglobulin M and G antibodies to Cryptosporidium in immunocompetent and immunocompromised persons. J Infect Dis. 1986;153:5708.PubMedGoogle Scholar
  10. Ungar  BL, Gilman  RH, Lanata  CF, Peres-Schael  I. Seroepidemiology of Cryptosporidium infection in two Latin American populations. J Infect Dis. 1988;157:5516.PubMedGoogle Scholar
  11. Ungar  BL, Mulligan  M, Nutman  TB. Serologic evidence of Cryptosporidium infection in US volunteers before and during Peace Corps service in Africa. Arch Intern Med. 1989;149:8947. DOIPubMedGoogle Scholar
  12. DuPont  HL, Chappell  CL, Sterling  CR, Okhuysen  PC, Rose  JB, Jakubowski  W. The infectivity of Cryptosporidium parvum in healthy volunteers. N Engl J Med. 1995;332:8559. DOIPubMedGoogle Scholar
  13. Haas  CN, Rose  JB. Reconciliation of microbial risk models and outbreak epidemiology: the case of the Milwaukee outbreak. Proceedings of the American Water Works Association 1994;517-23.
  14. Centers for Disease Control. Waterborne disease outbreaks, 1986-1988. MMWR CDC Surveill Summ. 1990;39:113.
  15. Fayer  R. Effect of sodium hypochlorite exposure on infectivity of Cryptosporidium parvum oocysts for neonatal BALB/c mice. Appl Environ Microbiol. 1995;61:8446.PubMedGoogle Scholar
  16. Korich  DG, Mead  JR, Madore  MS, Sinclair  NA, Sterling  CR. Effects of ozone, chlorine dioxide, chlorine, and monochloramine on Cryptosporidium parvum oocyst viability. Appl Environ Microbiol. 1990;56:14238.PubMedGoogle Scholar
  17. Rush  BA, Chapman  PA, Ineson  RW. Cryptosporidium and drinking water [Letter]. Lancet. 1987;2:6323. DOIPubMedGoogle Scholar
  18. D'Antonio  RG, Winn  RE, Taylor  JP, Gustafson  TL, Current  WL, Rhodes  MM, A waterborne outbreak of cryptosporidiosis in normal hosts. Ann Intern Med. 1985;103:8868.PubMedGoogle Scholar
  19. Smith  HV, Girdwood  RWA, Patterson  WJ, Hardie  R, Green  LA, Benton  C, Waterborne outbreak of cryptosporidiosis. Lancet. 1988;:1484. DOIPubMedGoogle Scholar
  20. Hayes  EB, Matte  TD, O'Brien  TR, McKinley  TW, Logsdon  GS, Rose  JB, Large community outbreak of cryptosporidiosis due to contamination of a filtered public water supply. N Engl J Med. 1989;320:13726.PubMedGoogle Scholar
  21. MacKenzie  WR, Hoxie  NJ, Proctor  ME, Gradus  MS, Blair  KA, Peterson  DE, A massive outbreak in Milwaukee of Cryptosporidium infection transmitted through the public water supply. N Engl J Med. 1994;331:1617. DOIPubMedGoogle Scholar
  22. McAnulty  JM, Fleming  DW, Gonzalez  AH. A community-wide outbreak of cryptosporidiosis associated with swimming at a wave pool. JAMA. 1994;272:1597600. DOIPubMedGoogle Scholar
  23. Moore  AC, Herwaldt  BL, Craun  GF, Calderon  RL, Highsmith  AK, Juranek  DD. Surveillance for water-borne disease outbreaks—United States, 1991-1992. MMWR CDC Surveill Summ. 1993;42:122.PubMedGoogle Scholar
  24. Kramer  MH, Herwaldt  BL, Craun  GF, Calderon  RL, Juranek  DD. Surveillance for waterborne-disease outbreaks—United States, 1993-1994. MMWR Morb Mortal Wkly Rep. 1996;45:133.PubMedGoogle Scholar
  25. Gerba  CP, Gerba  P. Journal of the Swimming Pool and Spa Industry. 1996;1:918.
  26. Steiner  TS, Thielman  NM, Guerrant  RL. Protozoal agents: what are the dangers for the public water supply. Annu Rev Med 1996.
  27. Millard  PS, Gensheimer  KF, Addiss  DG, Sosin  DM, Beckett  GA, Houck-Jankoski  A, An outbreak of cryptosporidiosis from fresh-pressed apple cider [published erratum appears in JAMA 1995 Mar8;273(10):776]. JAMA. 1994;272:15926. DOIPubMedGoogle Scholar
  28. Newman  RD, Zu  S-X, Wuhib  T, Lima  AAM, Guerrant  RL, Sears  CL. Household epidemiology of Cryptosporidium parvum infection. Ann Intern Med. 1994;120:5005.PubMedGoogle Scholar
  29. Cordell  RL, Addiss  DG. Cryptosporidiosis in child care settings: a review of the literature and recommendations for prevention and control. Pediatr Infect Dis J. 1994;13:3117.
  30. Diers  J, McCallister  GL. Occurrence of Cryptosporidium in home day-care centers in west-central Colorado. J Parasitol. 1989;75:6378. DOIPubMedGoogle Scholar
  31. Stehr-Green  JK, McCaig  L, Remson  HM, Raines  CS, Fox  M, Juranek  DD. Shedding of oocysts in immunocompetent individuals infected with Cryptosporidium. Am J Trop Med Hyg. 1987;36:33842.PubMedGoogle Scholar
  32. Baxby  D, Hart  CA, Taylor  C. Human cryptosporidiosis: a possible case of hospital cross infection. BMJ. 1983;287:17601. DOIPubMedGoogle Scholar
  33. Dryjanski  JD, Gold  JWM, Ritchie  MT, Kurt  RC, Lim  SL, Armstrong  D. Cryptosporidiosis. Case report in a health team worker. Am J Med. 1986;80:7512. DOIPubMedGoogle Scholar
  34. Collier  AC, Miller  RA, Meyers  JD. Cryptosporidiosis after marrow transplantation: person-to-person transmission and treatment with spiramycin. Ann Intern Med. 1984;101:2056.PubMedGoogle Scholar
  35. Gentile  G, Venditti  M, Micozzi  A, Caprioli  A, Donelli  G, Tirindelli  C, Cryptosporidiosis in patients with hematologic malignancies. Rev Infect Dis. 1991;13:8426.PubMedGoogle Scholar
  36. Navarrete  S, Stetler  HC, Avila  C, Aranda  JAG, Santos-Preciado  JI. An outbreak of Cryptosporidium diarrhea in a pediatric hospital. Pediatr Infect Dis J. 1991;10:24850. DOIPubMedGoogle Scholar
  37. Ravn  P, Lundgren  JD, Kjaeldgaard  P, Holten-Anderson  W, Hjlyng  N, Nielsen  JO, Nosocomial outbreak of cryptosporidiosis in AIDS patients. BMJ. 1991;302:27780. DOIPubMedGoogle Scholar
  38. Neill  MA, Rice  SK, Ahmad  NV, Flanigan  TP. Cryptosporidiosisan unrecognized cause of diarrhea in elderly hospitalized patients. Clin Infect Dis. 1996;22:16870.PubMedGoogle Scholar
  39. Koch  KL, Phillips  DJ, Aber  RC, Current  WL. Cryptosporidiosis in hospital personnel. Ann Intern Med. 1985;102:5936.PubMedGoogle Scholar
  40. Newman  RD, Wuhib  T, Lima  AA, Guerrant  RL, Sears  CL. Environmental sources of Cryptosporidium in an urban slum in northeastern Brazil. Am J Trop Med Hyg. 1993;49:2705.PubMedGoogle Scholar
  41. LeChevallier  MW, Norton  WD, Lee  RG. Occurrence of Giardia and Cryptosporidium spp. in surface water supplies [published erratum appears in Appl Environ Microbiol 1992 Feb;58:780]. Appl Environ Microbiol. 1991;57:26106.PubMedGoogle Scholar
  42. LeChevallier  MW, Schulz  W, Lee  RG. Bacterial nutrients in drinking water. Appl Environ Microbiol. 1991;57:85762.PubMedGoogle Scholar
  43. Guarino  A, Canani  RB, Casola  A, Pozio  E, Russo  R, Bruzzese  E, Human intestinal cryptosporidiosis: secretory diarrhea and enterotoxic activity in Caco-2 cells. J Infect Dis. 1995;171:97683.PubMedGoogle Scholar
  44. Sears  CL, Guerrant  RL. Cryptosporiodiosis: the complexity of intestinal pathophysiology. Gastroenterology. 1994;106:2524.PubMedGoogle Scholar
  45. Argenzio  RA, Rhoads  JM, Armstrong  M, Gomez  G. Glutamine stimulates prostaglandin-sensitive Na(+)-H+ exchange in experimental porcine cryptosporidiosis [see comments]. Gastroenterology. 1994;106:141828.PubMedGoogle Scholar
  46. Argenzio  RA, Lecce  J, Powell  DW. Prostanoids inhibit intestinal NaCl absorption in experimental porcine cryptosporidiosis. Gastroenterology. 1993;104:4407.PubMedGoogle Scholar
  47. Modigliani  R, Bories  C, LeCharpentier  Y, Salmeron  N, Messing  B, Galian  A. Diarrhea and malabsorption in acquired immune deficiency syndrome: a study of four cases with special emphasis on opportunistic protozoan infestations. Gut. 1985;26:17987. DOIPubMedGoogle Scholar
  48. Gardner  AL, Roche  JK, Weikel  CS, Guerrant  RL. Intestinal cryptosporidiosis: pathophysiologic alterations and specific cellular and humoral immune responses in rnu/+ and rnu/rnu (athymic) rats. Am J Trop Med Hyg. 1991;44:4962.PubMedGoogle Scholar
  49. Heine  J, Moon  HW, Woodmansee  DB. Persistent Cryptosporidium infection in congenitally athymic (nude) mice. Infect Immun. 1984;43:8569.PubMedGoogle Scholar
  50. Goodgame  RW, Kimball  K, Ou  CN, White  AC Jr, Genta  RM, Lifschitz  CH, Intestinal function and injury in acquired immunodeficiency syndrome-related cryptosporidiosis. Gastroenterology. 1995;108:107582. DOIPubMedGoogle Scholar
  51. Fang  G, Lima  AAM, Martins  CC, Nataro  JP, Guerrant  RL. Etiology and epidemiology of persistent diarrhea in northeastern Brazil: a hospital-based prospective case control study. J Pediatr Gastroenterol Nutr. 1995;21:13744. DOIPubMedGoogle Scholar
  52. Wuhib  T, Silva  TM, Newman  RD, Garcia  LS, Pereira  ML, Chaves  CS, Cryptosporidial and microsporidial infections in human immunodeficiency virus-infected patients in northeastern Brazil. J Infect Dis. 1994;170:4947.PubMedGoogle Scholar
  53. Weber  R, Bryan  RT, Bishop  HS, Wahlquist  SP, Sullivan  JJ, Juranek  DD. Threshold of detection of Cryptosporidium oocysts in human stool specimens: evidence for low sensitivity of current diagnostic methods. J Clin Microbiol. 1991;29:13237.PubMedGoogle Scholar
  54. Newman  RD, Jaeger  KL, Wuhib  T, Lima  AA, Guerrant  RL, Sears  CL. Evaluation of an antigen capture enzyme-linked immunosorbent assay for detection of Cryptosporidium oocysts. J Clin Microbiol. 1993;31:20804.PubMedGoogle Scholar
  55. Kehl  KS, Cicirello  H, Havens  PL. Comparison of four different methods for detection of Cryptosporidium species. J Clin Microbiol. 1995;33:4168.PubMedGoogle Scholar
  56. Laxer  MA, Timblin  BK, Patel  RJ. DNA sequences for the specific detection of Cryptosporidium parvum by the polymerase chain reaction. Am J Trop Med Hyg. 1991;45:68894.PubMedGoogle Scholar
  57. Laxer  MA, D'Nicuola  ME, Patel  R. Detection of Cryptosporidium parvum DNA in fixed, paraffin-embedded tissue by the polymerase chain reaction. Am J Trop Med Hyg. 1992;47:4505.PubMedGoogle Scholar
  58. Awad-El-Kariem  FM, Warhurst  DC, McDonald  V. Detection and species identification of Cryptosporidium oocysts using a system based on PCR and endonuclease restriction. Parasitology. 1994;109:1922. DOIPubMedGoogle Scholar
  59. White  AC Jr, Chappell  CL, Hayat  CS, Kimball  KT, Flanigan  TP, Goodgame  RW. Paromomycin for cryptosporidiosis in AIDS: a prospective, double-blind trial. J Infect Dis. 1994;170:41924.PubMedGoogle Scholar
  60. Lima  AAM, Soares  AM, Freire  JE Jr, Guerrant  RL. Cotransport of sodium with glutamine, alanine and glucose in the isolated rabbit ileal mucosa. Braz J Med Biol Res. 1992;25:63740.PubMedGoogle Scholar

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